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        <title>问卷测评</title>
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    <body>
        <header class="aui-bar aui-bar-nav" id="aui-header">
            <div class="aui-pull-left aui-btn" onclick="close_win();">
                <span class="aui-iconfont aui-icon-left"></span>返回
            </div>
            <div class="aui-title">孤独症评定表报告单</div>
        </header>
        <div class="aui-grid">
            <div class="aui-row">
                <div class="TestBody">
                    <div class="containerQuestion">
                        <div class="label">病案号：</div>
                        <div class="inputClass"><input type="text" /></div>
                    </div>
                </div>
            </div>
            <div class="GridBody">
                第一部分 儿童资料
                <div class="aui-row">
                    <div class="containerQuestion">
                        <div class="label">儿童姓名：</div>
                        <div class="inputClass"><input type="text" /></div>
                        &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                        <div class="label">性&nbsp;&nbsp;&nbsp;&nbsp;别：</div>
                        <div class="inputClass"><input type="password" /></div>
                    </div>
                    <div class="containerQuestion">
                        <div class="label">出生日期：</div>
                        <div class="inputClass">
                            <div class="date">
                                <input type="text" class="date-item" />年
                                <input type="text" class="date-item" />月
                                <input type="text" class="date-item" />日
                            </div>
                        </div>
                        &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                        <div class="label">评估日期：</div>
                        <div class="inputClass">
                            <div class="date">
                                <input type="text" class="date-item" />年
                                <input type="text" class="date-item" />月
                                <input type="text" class="date-item" />日
                            </div>
                        </div>
                    </div>
                    <div class="containerQuestion">
                        <div class="label">年&nbsp;&nbsp;&nbsp;&nbsp;龄：</div>
                        <div class="inputClass">
                            <div class="date">
                                <input type="text" class="date-item" />岁
                                <input type="text" class="date-item" />月
                                <input type="text" class="date-item" />天
                            </div>
                        </div>
                        &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                        <div class="label">诊&nbsp;&nbsp;&nbsp;&nbsp;断：</div>
                        <div class="inputClass"><input type="text" /></div>
                    </div>
                </div>
            </div>

            <div class="GridBody">
                第二部分 自闭症行为检查表（ABC）
                <div class="aui-row">
                    <table class="TableBody1">
                        <tr>
                            <th>项目</th>
                            <th>躯体</th>
                            <th>自理</th>
                            <th>感觉</th>
                            <th>语言</th>
                            <th>交往</th>
                        </tr>
                        <tr>
                            <td>评&nbsp;分</td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                        </tr>
                        <tr>
                            <td>总&nbsp;分</td>
                            <td colspan="5"><input type="text" /></td>
                        </tr>
                    </table>
                </div>
            </div>
            <div class="GridBody">
                第三部分 儿童自闭症评定量表（CARS-2）
                <div class="aui-row">
                    <table class="TableBody1">
                        <tr>
                            <th>人际关系</th>
                            <th>模仿</th>
                            <th>情感反应</th>
                            <th>躯体运用能力</th>
                            <th>与非生物体关系</th>
                            <th>对环境变化的适应</th>
                        </tr>
                        <tr>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                        </tr>
                        <tr>
                            <th>视觉反应</th>
                            <th>听觉反应</th>
                            <th>感觉器官对刺激的反应</th>
                            <th>焦虑反应</th>
                            <th>语言交流</th>
                            <th>非语言交流</th>
                        </tr>
                        <tr>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                        </tr>
                        <tr>
                            <th>活动水平</th>
                            <th>智力功能</th>
                            <th>总的印象</th>
                            <th>总分</th>
                        </tr>
                        <tr>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                        </tr>
                    </table>
                </div>
            </div>
            <div class="GridBody">
                第四部分 社交反应量表（SRS）
                <div class="aui-row">
                    <table class="TableBody1">
                        <tr>
                            <th>项目</th>
                            <th>社交动机</th>
                            <th>社交知觉</th>
                            <th>孤独症行为模式</th>
                            <th>社交认知</th>
                            <th>社交沟通</th>
                        </tr>
                        <tr>
                            <td>评&nbsp;分</td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                        </tr>
                        <tr>
                            <td>总&nbsp;分</td>
                            <td colspan="5"><input type="text" /></td>
                        </tr>
                    </table>
                </div>
            </div>

            <div class="GridBody">
                第五部分 孤独症疗效评定量表（ATEC）
                <div class="aui-row">
                    <table class="TableBody1">
                        <tr>
                            <th>项目</th>
                            <th>言语/语言/交流</th>
                            <th>社交性</th>
                            <th>感知/认知觉察</th>
                            <th>健康生理行为</th>
                        </tr>
                        <tr>
                            <td>评&nbsp;分</td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                        </tr>
                        <tr>
                            <td>总&nbsp;分</td>
                            <td colspan="4"><input type="text" /></td>
                        </tr>
                    </table>
                </div>
            </div>

            <div class="GridBody">
                第六部分 重复刻板行为量表
                <div class="aui-row">
                    <table class="TableBody1">
                        <tr>
                            <th>项目</th>
                            <th>刻板行为</th>
                            <th>自伤行为</th>
                            <th>强迫行为</th>
                            <th>仪式行为</th>
                            <th>单调行为</th>
                            <th>受限行为</th>
                        </tr>
                        <tr>
                            <td>评&nbsp;分</td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                            <td><input type="text" /></td>
                        </tr>
                        <tr>
                            <td>总&nbsp;分</td>
                            <td colspan="6"><input type="text" /></td>
                        </tr>
                    </table>
                </div>
            </div>
            <div class="GridBody evaluationBody">
                <div>结论：</div>
                <div class="aui-row TestBody">
                    <div class="containerQuestion">
                        <div class="label">测评人</div>
                        <div class="inputClass"><input type="text" /></div>
                    </div>
                </div>

                <div class="aui-row TestBody">
                    <div class="containerQuestion">
                        <div class="label">测评日期</div>
                        <div class="inputClass">
                            <div class="date">
                                <input type="text" class="date-item" />年
                                <input type="text" class="date-item" />月
                                <input type="text" class="date-item" />日
                            </div>
                        </div>
                    </div>
                </div>
            </div>
            <div class="GridBody">
                <div class="aui-row">
                    <div class="QuestionStyle">
                        <div class="aui-btn aui-btn-info">提交</div>
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